A Family Navigator Intervention to Improve ADHD- Related Treatment Adherence (I2-ART) for Minority Children

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PROJECT SUMMARY/ABSTRACT I am a developmental-behavioral pediatrician who has earned an MS in Clinical Research. My long-term goal is to become an independent researcher focused on advancing developmental-behavioral outcomes of children from diverse, underserved groups by improving their adherence to treatment plans for mental health conditions, including attention-deficit hyperactivity disorder (ADHD). My current objective, which represents the next step in pursuit of this goal, is to develop a culturally-tailored family navigator Intervention to Improve ADHD-Related Treatment adherence (I2-ART) for minority children using a systematic, patient-centered, iterative approach consistent with the ORBIT model for behavioral intervention development. Key elements of the career development plan to support both my long-term goal and current objective include training in (1) the design and evaluation of clinical and mental health services trials to improve treatment adherence, (2) health disparities and community-partnered research, and (3) effective grant and manuscript writing. My mentorship team includes NIH-funded investigators with expertise in ADHD, clinical trial design, treatment adherence, health disparities, and community-partnership research. Furthermore, Cincinnati Children’s Hospital, which ranks #2 among U.S. children’s hospitals for NIH funding, provides an outstanding research environment and strong support for junior faculty, including >30 current recipients of NIH Career Development Awards. Proposed Research: ADHD is the most common pediatric neurodevelopmental disorder and is associated with significant long-term impairments. Current guidelines recommend stimulant medication and/or behavioral therapy as first-line treatments for ADHD. Despite evidence that consistent treatment is important for effectively managing ADHD symptoms, treatment adherence remains suboptimal and is especially problematic among minority children. Hypothesized reasons for racial/ethnic disparities in ADHD treatment include uncertainties about medication efficacy and side effects, distrust of the health care system, and decreased access to mental health services. This study aims to develop and test the I2-ART intervention to improve treatment adherence in minority (Latinx and African American) children with ADHD. The proposed study involves three ORBIT phases: During phase 1a, we will conduct focus groups with key stakeholders (i.e., caregivers, clinicians, and family navigators, n=24) to identify and develop I2-ART’s basic elements. Next, during phase 1b, we will train four family navigators to implement I2-ART with caregivers of treatment-naïve children with ADHD (n=8-12) in order to determine feasibility and acceptability. In phase 2, we will use phase 1b findings to modify I2-ART as needed, and then will evaluate the preliminary efficacy of the revised I2-ART (n=40), compared to the “usual care” control condition (n=20), on ADHD treatment adherence. The preliminary data collected during the proposed study will inform a subsequent R01 randomized controlled trial to examine I2-ART efficacy.